title: Clopidogrel with aspirin in acute minor stroke or transient ischemic attack.
abstract: BACKGROUND
  Stroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Combination therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone.
  
  
  METHODS
  In a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China, we randomly assigned 5170 patients within 24 hours after the onset of minor ischemic stroke or high-risk TIA to combination therapy with clopidogrel and aspirin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, plus aspirin at a dose of 75 mg per day for the first 21 days) or to placebo plus aspirin (75 mg per day for 90 days). All participants received open-label aspirin at a clinician-determined dose of 75 to 300 mg on day 1. The primary outcome was stroke (ischemic or hemorrhagic) during 90 days of follow-up in an intention-to-treat analysis. Treatment differences were assessed with the use of a Cox proportional-hazards model, with study center as a random effect.
  
  
  RESULTS
  Stroke occurred in 8.2% of patients in the clopidogrel-aspirin group, as compared with 11.7% of those in the aspirin group (hazard ratio, 0.68; 95% confidence interval, 0.57 to 0.81; P<0.001). Moderate or severe hemorrhage occurred in seven patients (0.3%) in the clopidogrel-aspirin group and in eight (0.3%) in the aspirin group (P=0.73); the rate of hemorrhagic stroke was 0.3% in each group.
  
  
  CONCLUSIONS
  Among patients with TIA or minor stroke who can be treated within 24 hours after the onset of symptoms, the combination of clopidogrel and aspirin is superior to aspirin alone for reducing the risk of stroke in the first 90 days and does not increase the risk of hemorrhage. (Funded by the Ministry of Science and Technology of the People's Republic of China; CHANCE ClinicalTrials.gov number, NCT00979589.).
authors.affiliation: Beijing Tiantan Hospital, Capital Medical University, Beijing, China. yongjunwang1962@gmail.com
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.forename: Xia
authors.initials: X
authors.lastname: Meng
authors.forename: Liying
authors.initials: L
authors.lastname: Cui
authors.forename: Jianping
authors.initials: J
authors.lastname: Jia
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dong
authors.forename: Anding
authors.initials: A
authors.lastname: Xu
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Zeng
authors.forename: Yansheng
authors.initials: Y
authors.lastname: Li
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Wang
authors.forename: Haiqin
authors.initials: H
authors.lastname: Xia
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D000077144:Clopidogrel; D018572:Disease-Free Survival; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin